The men are now on a mission to get people tested for kidney disease and to get living donors.

"It's such an epidemic and I've seen it first hand from when I started dialysis," said Malcolm.

"There's close to 3,000 people in Hawaii on dialysis. I think back when I first started in 1995. There were less than 1,000," said Glenn Hayashida of the National Kidney Foundation Hawaii.

According to the National Kidney Foundation, chronic kidney disease affects more than 160,000 people in Hawaii. That is 30 percent higher than the national average.

Native Hawaiians and Polynesians are at the highest risk, but it also strikes Filipinos and Japanese in high numbers.

"You know for whatever reason, our western lifestyle just doesn't match well with genetics," said Hayashida.

Diabetes is by far the most common cause, along with high blood pressure and genetics, which was Malcolm's case. But also, abuse of simple pain killers like Advil and Motrin can lead to kidney problems.

Malcolm's doctors first detected protein in his urine in the 1990s, but it was explainable since he was a strong man competitor lifting huge weights. The protein returned in 2003 even after he retired from competition. Doctors monitored Malcolm and in 2008, they told him he had stage-four kidney disease. His kidneys were only functioning at 8 percent.

"I never had signs. I never had symptoms. I was still doing what I used to do. It just happened," said Malcolm. "So people don't know they got to get tested. A simple urine test with your doctor can probably save you a lot of humbug after."

"People should get tested to find out not only if you're not well, but to find out if you are well," said Pono.

450 people in Hawaii are on the waiting list for kidney transplants and transplant officials say living donors are the best.

"In general a patient who receives a living donor kidney, they tend to have not as many potential complications as a deceased donor. Due to the fact that it's out of the body, we call it cold time," said Queen's Transplant Education Coordinator Anthony Alvarado. "There's not as much risk or as many complication from it being cold."

But in recent years Hawaii donors have been reluctant to come forward.

In the last four years only 28 living donor transplants took place here. Hayashida thinks a lot of momentum was lost with the closure of Hawaii Medical Center West. He is hopeful it will return now that Queen's Medical Center has taken over the transplants. The kidney foundation hopes that more healthy people will make that choice after learning there is no real change living with one less kidney.

"The risk for going into renal failure after donating is no different than any other person in the population," said Alvarado.

And Pono is proof.

"I don't have kidney disease. I have one kidney," said Pono.

Then there's the gift donor recipients get, seeing children and grandchildren grow up and growing old with the one they love.